Key takeaways
- Treatment-induced menopause can be temporary or permanent. Symptoms can arrive more suddenly than natural menopause, and be more intense.
- The physical and psychological impact of treatment-induced menopause when experienced after a cancer diagnosis and treatment, can be profound
- Not all ways of managing menopausal symptoms, including medication and lifestyle changes, may be suitable for everyone
- Mindfulness and meditation can help women arrive at a place of acceptance and self-kindness, and teach techniques to help manage symptoms
Menopause is generally a natural event for all women and usually occurs between the ages of around 45 and 55 years. It’s the time when a woman stops having periods. Periods generally become irregular in the months and years before the menopause and this is known as ‘perimenopause’. Treatment for cancer such as surgery, chemotherapy, hormone therapy and radiotherapy, may result in an early menopause or menopausal symptoms.
Many women will need support during this time to cope with the physical and emotional impact of the menopause. We asked Perci Health’s Lead Cancer Nurse Specialist Rachel Rawson, and mindfulness and meditation professional, Laura Ashurst, for their advice around managing treatment-induced menopause.
Right at the beginning of my cancer treatment, my oncologist told me that I would go into medically-induced menopause, but that when my treatment stopped, I would probably go back to normal. That didn’t happen.
Treatment-induced menopause is so intense. The hot flushes were completely debilitating. Everyone tells you to sleep, but my symptoms meant that I couldn’t, even though I was bone tired. The brain fog is also really difficult. Work that should have taken a week, took me three. I felt like I had marshmallows for brains! Halfway through a sentence I’d forget what I was talking about. Luckily, when the chemo stopped, that lifted.
When you throw the menopause in with cancer, it can be very isolating and I don’t think there is enough support. They give you advice and tell you to read a lot, but that’s about it. It was a very difficult thing to manage but, luckily, I had an amazing support system.
I’ve finished treatment now. The menopause symptoms are still here, but less intense and less frequent, although I never had another period. I could be going through perimenopause, or natural menopause – it all feels very unknown.
Farah, Perci Health member
How does cancer treatment affect menopause?
Menopause can happen as a result of cancer treatment and its effect on the ovaries. The ovaries produce the hormones oestrogen and progesterone, which control a woman’s periods. During the natural menopause, the ovaries stop producing these hormones over time and periods gradually stop.
Cancer treatments such as chemotherapy and radiotherapy to the pelvis (the area between the hip bones) can affect the way the ovaries work, causing temporary or earlier menopause. Surgery to remove both ovaries has the same effect. The menopause is more likely to be permanent if you are closer to the natural age when periods would stop. Your doctor might be able to say whether your menopause is likely to be temporary or permanent, but this will be difficult to know for sure.
Menopausal symptoms can also be common for women who are taking hormone therapy as part of their breast cancer treatment. Some breast cancers use oestrogen in the body to help them to grow; these are called oestrogen receptor positive breast cancers. A number of hormone therapies work in different ways to block the effect of oestrogen or reduce the amount of oestrogen in the body, which can also cause menopausal symptoms. These can be difficult to manage, especially as the treatment may continue for five to ten years.
What are the physical symptoms of treatment-related menopause?
Each woman’s experience of menopause is unique, and this is the case whether the menopause is natural or as a result of cancer treatment. Menopause can arrive very suddenly and intensely, as in the case of ovary removal, whereas hormonal therapies may bring a more gradual change. Here are some of the most common physical symptoms:
- Hot flushes
- Night sweats
- Vaginal dryness
- Changes to sex drive
- Weight gain
- Heart palpitations
- Difficulty sleeping
- Crawling sensation under the skin
What are the psychological symptoms of menopause?
The direct psychological symptoms of menopause, whether natural or as a result of treatment can include low mood, anxiety, and loss of focus and memory. Combined, this can lead to a sense of overwhelm.
For mindfulness and meditation practitioner, Laura Ashurst, the element of grief and loss that can be involved, is also vital to address: ‘It depends where the person is in their life experience, but if induced menopause means that you can’t have children, your future might suddenly look very different to what you had imagined, and that’s a huge thing to deal with.’
If induced menopause means that you can’t have children, your future might suddenly look very different to what you had imagined, and that’s a huge thing to deal with.
Laura Ashurst, meditation and mindfulness professional
How to cope with some of the physical and psychological effects of the menopause
Coping with menopausal symptoms alongside the side-effects of cancer treatment can be really challenging. There are some things that you can try yourself but you might also want to speak to your treatment team, gynaecologist or GP about other things that may help.
- Prescription drugs may be an option
- Reducing food or drinks that trigger menopausal symptoms
- Exercising and maintaining a healthy weight
- Cognitive behavioural therapy (CBT), hypnotherapy, mindfulness and talking therapies
- Vaginal lubricants and moisturisers for vaginal dryness
Managing menopause symptoms with mindfulness
By Perci meditation and mindfulness professional, Laura Ashurst.
‘Anyone can practise mindfulness, and there’s no better time to start than during the menopause, when you’re called to embrace a new and very different version of yourself while also coping with grief or loss. Mindfulness can encourage you to acknowledge how it feels to experience another layer of suffering on top of your treatment, and to turn towards the experience with kindness and compassion rather than resistance. As the saying goes, what we resist, persists.’
There’s no better time to learn mindfulness than during the menopause, when you’re called to embrace a new and very different version of yourself while also coping with a sense of grief or loss.
Laura Ashurst, meditation and mindfulness professional
Why is mindfulness helpful during treatment-induced menopause?
‘The impact of treatment-induced menopause is profound and it’s rare for women to feel they’re receiving the right level of support. It’s so easy to feel like you’re floundering, and to berate yourself. You might feel silly or tell yourself that you should be coping better. When we can’t do things as well as we would have done, there’s also a tendency to mask it; to show people that we can. But that’s counterproductive for our nervous system. Mindfulness can help us attach less importance to what other people think and pay more attention to taking nurturing self-care steps.’
What to expect in mindfulness sessions
‘Menopause comes with a huge list of symptoms, experienced to varying degrees. Our work together would start with what is present right now, physically and emotionally, for you. It’s important that this is said out loud and acknowledged. Then we take a step back and look at the enormity of the situation, before focusing on working towards coming to that point of acceptance. If there’s a partner involved, they need to understand and accept what’s going on, too. Ultimately, we’re building towards loving kindness meditations.’
How to approach menopause symptoms with mindfulness
‘When you’ve practised mindfulness, you’ll be able to use it throughout your day. You can use it in moments of overwhelm, like having a debilitating hot flush in a public place, or in the night. You’d typically work through three steps:
- Acknowledge the moment without pretending it’s not happening
- Identify where the physical or emotional response is happening in the body
- Do a short breathing exercise, knowing that it’s going to pass
What this does is to help reduce anxiety. Mindfulness teaches that everything is impermanent, so you know that the unpleasant sensations will pass.
‘You’ll learn to do body scans, especially at bedtime or when you’ve woken up with a hot flush. These reset the nervous system, so you can fall asleep again more easily. You can also create moments in the day to pause, close your eyes and focus on your breathing, so you can acknowledge where you are physically and emotionally. You can evaluate how kind or unkind you’ve been to yourself, draw a line underneath it and move on.’
Managing treatment-induced menopause can feel challenging and isolating, but you don’t have to go through it alone. Our cancer nurse specialists can answer your questions and refer you to menopause practitioners working with Perci Health.
While we have ensured that every article is medically reviewed and approved, information presented here is not intended to be a substitute for professional medical advice, diagnosis, or treatment. If you have any questions or concerns, please talk to one of our healthcare professionals or your primary healthcare team.
References
‘Menopause and cervical cancer’, jostrust.org.uk, September 2019, https://www.jostrust.org.uk/information/living-with-cervical-cancer/menopause
‘Menopausal symptoms and cancer treatment’, macmillan.org.uk, October 2018, https://www.macmillan.org.uk/cancer-information-and-support/impacts-of-cancer/menopausal-symptoms-and-cancer-treatment
‘Menopausal symptoms and breast cancer’, breast cancer now.org, https://breastcancernow.org/sites/default/files/publications/pdf/menopausal_web_0.pdf